Medical Assistance Transportation Program. A non-emergency medical transportation service provided to eligible persons who need to make trips to and from a MA reimbursable service for the purpose of receiving treatment, medical evaluation, or purchasing prescription drugs or medical equipment. Medically Necessary — A service or benefit that is compensable under the MA Program and if it meets any one of the following standards: Member — An individual who is enrolled with a PH-MCO under the HealthChoices Program and for whom the PH-MCO has agreed to arrange the provision of PH Services under the provisions of the HealthChoices Program. Member Record — A record on the Daily 834 Eligibility File or the Monthly 834 Eligibility File that contains information on MA eligibility, managed care coverage, Midwifery Practice — Management of the care of essentially healthy women and their healthy neonates (initial twenty-eight [28] day period), including intrapartum, postpartum and gynecological care. Monthly834 Eligibility File — An electronic file in a HIPAA compliant 834 format using data from CIS/eCIS that is transmitted to the PH-MCO on a monthly basis. Network — All contracted or employed Providers in the PH-MCO who are providing covered services to Members. Network Provider — any provider, group of providers, or entity that has a network provider agreement with a PH-MCO or a Subcontractor, and receives Medicaid funding directly or indirectly to order, refer or render covered services as a result of the state’s contract with a PH-MCO. A network provider is not a Subcontractor by virtue of the network provider agreement. Non-participating Provider — A Health Care Provider not enrolled in the Pennsylvania Medicaid Program. Nonrisk Contract — A contract between the State and a PIHP or PAHP under which the contractor (1) Is not at financial risk for changes in utilization or for costs incurred under the contract that do not exceed the upper payment limits specified in 42 C.F.R. §447.362 and (2) May be reimbursed by the State at the end of the contract period on the basis of the incurred costs, subject to the specified limits. Nursing Facility — A general, county or hospital-based nursing facility, which is licensed by the DOH, enrolled in the MA Program and certified for Medicare participation. The Provider types and specialty codes are as follows: OMAP Hotlines — Department phone lines designed to address and facilitate resolution of issues encountered by Recipients and their advocates or Providers according ...
Medical Assistance Transportation Program. (MATP) — A non-emergency medical transportation service provided to eligible persons who need to make trips to/from a MA reimbursable service for the purpose of receiving treatment, medical evaluation, or purchasing prescription drugs or medical equipment. Medically Necessary — A service or benefit is Medically Necessary if it is compensable under the MA Program and if it meets any one of the following standards: Member — An individual who is enrolled with a PH-MCO under the HealthChoices Program and for whom the PH-MCO has agreed to arrange the provision of Physical Health Services under the provisions of the HealthChoices Program. Member Record — A record contained on the Daily Membership File or the Monthly Membership File that contains information on MA eligibility, managed care coverage, and the category of assistance, which help establish the covered services for which a Recipient is eligible. Midwifery Practice — Management of the care of essentially healthy women and their healthy neonates (initial twenty-eight [28] day period). This includes intrapartum, postpartum and gynecological care. Network — All contracted or employed Providers in the PH-MCO who are providing covered services to Members. Network Provider — A Medical Assistance enrolled Health Care Provider who has a written Provider Agreement with and is credentialed by a HealthChoices PH-MCO and who participates in the PH-MCO’s Provider Network to serve HealthChoices Members. Net Worth (Equity) — The residual interest in the assets of an entity that remains after deducting its liabilities. Non-participating Provider — A provider, whether a person, firm, corporation or other entity, either not enrolled in the Pennsylvania MA Program or not participating in the PH-MCO’s Network, which provides medical services or supplies to PH-MCO Members. Nursing Facility — A general, county or hospital-based nursing facility, which is licensed by the DOH, enrolled in the MA Program and certified for Medicare participation. The Provider types and specialty codes are as follows: OMAP Hotlines — The PH-MCO will cooperate with the functions of OMAP’s Hotlines, which are designed to address clinically-related systems issues encountered by Recipients and their advocates or Providers. The OMAP Hotlines facilitate resolution according to PH-MCO policies and procedures and do not impose additional obligations on the PH-MCO. Ongoing Medication — A medication that has been previously dispensed to the Member for the ...
Medical Assistance Transportation Program. (MATP) — A non-emergency medical transportation service provided to eligible persons who need to make trips to or from any MA service for the purpose of receiving treatment, medical evaluation, or purchasing prescription drugs or medical equipment. Medically Necessary (also referred to as Medical Necessity) — Compensable under the MA Program and meeting any one of the following standards: Medicare — The federal health insurance program administered by CMS pursuant to 42 U.S.C. §§ 1395 et seq., covering almost all Americans sixty-five
Medical Assistance Transportation Program. A non-emergency medical transportation service provided to eligible persons who need to make trips to and Medically Necessary — A service or benefit that is compensable under the MA Program and if it meets any one of the following standards: Member — An individual who is enrolled with a PH-MCO under the HealthChoices Program and for whom the PH-MCO has agreed to arrange the provision of PH Services under the provisions of the HealthChoices Program. Member Record — A record on the Daily 834 Eligibility File or the Monthly 834 Eligibility File that contains information on MA eligibility, managed care coverage, and the category of assistance, which help establish the covered services for which a Recipient is eligible. Midwifery Practice — Management of the care of essentially healthy women and their healthy neonates (initial twenty-eight [28] day period), including intrapartum, postpartum and gynecological care. Monthly834 Eligibility File — An electronic file in a HIPAA compliant 834 format using data from CIS that is transmitted to the PH-MCO on a monthly basis. Network — All contracted or employed Providers in the PH-MCO who are providing covered services to Members. Network Provider — any provider, group of providers, or entity that has a network provider agreement with a PH-MCO or a Subcontractor, and receives Medicaid funding directly or indirectly to order, refer or render covered services as a result of the state’s contract with a PH-MCO. A network provider is not a Subcontractor by virtue of the network provider agreement. Non-participating Provider — A Health Care Provider, either not enrolled in the Pennsylvania MA Program or not participating in the PH-MCO’s Network, which provides medical services or supplies to Members. Nonrisk Contract — A contract between the State and a PIHP or PAHP under which the contractor (1) Is not at financial risk for changes in utilization or for costs incurred under the contract that do not exceed the upper payment limits specified in 42 C.F.R. §447.362 and (2) May be reimbursed by the State at the end of the contract period on the basis of the incurred costs, subject to the specified limits. Nursing Facility — A general, county or hospital-based nursing facility, which is licensed by the DOH, enrolled in the MA Program and certified for Medicare participation. The Provider types and specialty codes are as follows: OMAP Hotlines — Department phone lines designed to address and facilitate resolution of issues encounte...
Medical Assistance Transportation Program. MBE -- Minority Business Enterprise. MCO -- Managed Care Organization. MDW -- Xxxxxxx Dallas Waiver. MIS -- Management Information System. NCQA -- National Committee for Quality Assurance. NPDB -- National Practitioner Data Bank. OBRA -- Omnibus Budget Reconciliation Act. OCYF -- Office of Children, Youth and Families. OIP -- Other Insurance Paid. OMAP -- Office of Medical Assistance Programs. OMHSAS -- Office of Mental Health and Substance Abuse Services. OMR -- Office of Mental Retardation. ORC -- Other Related Conditions. OSP -- Office of Social Programs. PARP -- Prior Authorization Review Panel. PBM -- Pharmacy Benefit Manager. PCP -- Primary Care Practitioner. PDA -- Pennsylvania Department of Aging. PERT -- Program Evaluation and Review Technique. PH -- Physical Health. PH-MCO -- Physical Health Managed Care Organization. PMPM -- Per Member, Per Month. QARI -- Quality Assurance Reform Initiative. QM -- Quality Management. QMC -- Quality Management Committee. QM/UMP -- Quality Management and Utilization Management Program. RBUC -- Reported But Unpaid Claim. RFP -- Request for Proposal. RPAA -- Risk Pool Allocation Amount. RTF -- Residential Treatment Facility. SAP -- Statutory Accounting Principles. SERB -- Socially/Economically Restricted Business. SNU -- Special Needs Unit. SPR -- Systems Performance Review. SSA -- Social Security Act. SSI -- Supplemental Security Income. STD -- Sexually Transmitted Disease. TANF -- Temporary Assistance for Needy Families. TCM -- Targeted Case Management. TPL -- Third Party Liability. TTY -- Text Telephone Typewriter. UM -- Utilization Management. URCAP -- Utilization Review Criteria Assessment Process. U.S. DHHS -- United States Department of Health and Human Services. WBE -- Women's Business Enterprise. WIC -- Women's, Infants' and Children (Program).
Medical Assistance Transportation Program. Between the Department of Human Services, Bureau of Managed Care Operations and Modivcare
